Metaplastic Tumour of the Breast: A case presentation
Keywords:
Metaplastic carcinoma, Phyllodes tumour, Breast, Biopsy
Abstract
Metaplastic carcinoma (MPC) is a rare breast neoplasm with an incidence of 0-2.5%.Metaplastic spindle cell carcinoma should always be considered in the differential diagnosis of atypical spindle cell proliferations of the breast. We describe the diagnostic challenge posed by a MPC (Spindle cell type) in differentiating it from a Phyllodes tumour (PT) with epithelial hyperplasia on a trucut biopsy. Conventionally, CK and Vimentin co-expression by spindle cells is taken as an evidence for a diagnosis of MPC, but recently, heterogenous CK expression by spindle cells in MPC has been described. Therefore, in such a setting it is not advisable to make a definitive diagnosis of either MPC or PT on a trucut biopsy. However, a few histological and immunohistochemical considerations may help us in deciding the diagnosis. Histologically, blending of squamous cells with spindle cells, presence of extensive lymphocytic infiltrate, keloid-like stromal areas and presence of DCIS, favour the diagnosis of MPC over PT. Absence of CK, EGFR, p63 expression and positive CD34 and bcl-2 expression by spindle stromal cells favours PT over MPC.References
1) Lakhani SR, Ellis IO, Schnitt SJ, Tan PH, Vande Vijver MJ. WHO Classification of tumours of the breast. 4th ed. Lyon, France. IARC Press. 2012: p 48-53.
2) Dunne B, Lee AHS, Pinder SE, Bell JA, Ellis IO. An immunohistochemical study of metaplastic spindle cell carcinoma, phyllodes tumor and fibromatosis of the breast. Hum Pathol 2003;34:1009–15.
3) Chia Y, Thike AA, Cheok PY, Yong-Zheng Chong L, Man-Kit, Tse G et al. Stromal keratin expression in phyllodes tumours of the breast: a comparison with other spindle cell breast lesions. J Clin Pathol 2012; 65(4): 339-47.
4) Koker MM, Kleer CG. p63 expression in breast cancer: a highly sensitive and specific marker of metaplastic carcinoma. Am J Surg Pathol 2004; 28: 1506–12.
5) Leibl S, Moinfar F. Metaplastic breast carcinomas are negative for Her-2 but frequently express EGFR (Her-1): potential relevance to adjuvant treatment with EGFR tyrosine kinase inhibitors?J. Clin. Pathol. 2005; 58: 700–4.
6) Hoda SA, Brogi E, Koerner FC, Rosen PP. Rosen's Breast Pathology. 4TH ed. Philadelphia. Lippincott Williams and Wilkins. 2014
7) Tan PH, Jayabaskar T, Chuah KL, Lee HY, Tan Y, Hilmy N et al. Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol. 2005; 123: 529–40.
2) Dunne B, Lee AHS, Pinder SE, Bell JA, Ellis IO. An immunohistochemical study of metaplastic spindle cell carcinoma, phyllodes tumor and fibromatosis of the breast. Hum Pathol 2003;34:1009–15.
3) Chia Y, Thike AA, Cheok PY, Yong-Zheng Chong L, Man-Kit, Tse G et al. Stromal keratin expression in phyllodes tumours of the breast: a comparison with other spindle cell breast lesions. J Clin Pathol 2012; 65(4): 339-47.
4) Koker MM, Kleer CG. p63 expression in breast cancer: a highly sensitive and specific marker of metaplastic carcinoma. Am J Surg Pathol 2004; 28: 1506–12.
5) Leibl S, Moinfar F. Metaplastic breast carcinomas are negative for Her-2 but frequently express EGFR (Her-1): potential relevance to adjuvant treatment with EGFR tyrosine kinase inhibitors?J. Clin. Pathol. 2005; 58: 700–4.
6) Hoda SA, Brogi E, Koerner FC, Rosen PP. Rosen's Breast Pathology. 4TH ed. Philadelphia. Lippincott Williams and Wilkins. 2014
7) Tan PH, Jayabaskar T, Chuah KL, Lee HY, Tan Y, Hilmy N et al. Phyllodes tumors of the breast: the role of pathologic parameters. Am J Clin Pathol. 2005; 123: 529–40.
Published
2015-05-10
Issue
Section
Case Report
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access at http://opcit.eprints.org/oacitation-biblio.html).
